Initial clinical outcomes of proton beam radiotherapy for hepatocellular carcinoma

Abstract

PurposeThis study aimed to evaluate the initial outcomes of proton beam therapy (PBT) for hepatocellular carcinoma (HCC) in terms of tumor response and safety.Materials and MethodsHCC patients who were not indicated for standard curative local modalities and who were treated with PBT at Samsung Medical Center from January 2016 to February 2017 were enrolled. Toxicity was scored using the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. Tumor response was evaluated using modified Response Evaluation Criteria in Solid Tumors (mRECIST).ResultsA total of 101 HCC patients treated with PBT were included. Patients were treated with an equivalent dose of 62–92 GyE10. Liver function status was not significantly affected after PBT. Greater than 80% of patients had Child-Pugh class A and albumin-bilirubin (ALBI) grade 1 up to 3-months after PBT. Of 78 patients followed for three months after PBT, infield complete and partial responses were achieved in 54 (69.2%) and 14 (17.9%) patients, respectively.ConclusionPBT treatment of HCC patients showed a favorable infield complete response rate of 69.2% with acceptable acute toxicity. An additional follow-up study of these patients will be conducted.

Do Biliary Complications after Proton Beam Therapy for Perihilar Hepatocellular Carcinoma Matter?

“…As a dose-response relationship has been reported in RT for HCC, there have been efforts to safely deliver high-dose radiation to the primary HCC using advanced RT techniques [ 6 , 22 , 23 ]. PBT is one of the most advanced forms of RT, and its use in the treatment of primary HCC is expanding [ 10 , 22 ]. The safety of PBT for primary HCC is reliable with regard to RILD or gastroduodenal toxicities after PBT [ 9 ].…”

“…Therefore, the use of RT has been increased as a combined or alternative modality to standard therapy [ 4 , 5 , 6 ]. Furthermore, with advances in RT technologies, including stereotactic body RT and proton beam therapy (PBT), the highly accurate delivery of high-dose radiation to primary HCC has resulted in excellent local control after RT without an increased risk of radiation-induced liver disease, which had previously been the main concern of liver-directed RT [ 7 , 8 , 9 , 10 , 11 ]. Among the complications of treatments for primary HCC, biliary complications including bile duct stricture or biloma are important issues.…”

Clinical significance of radiotherapy before and/or during nivolumab treatment in hepatocellular carcinoma

“…Compared with the role of RT as a main locoregional modality in other oncologic fields, its use in managing HCC has been very limited because of the radiosensitive nature of cirrhotic non‐tumor liver and the relative radioresistance of HCC. With the rapid advancement in RT techniques and radiation biology, favorable outcomes in prospective studies and the clinical application of liver‐directed RT have been recently increasing . In fact, several guidelines have recently recommended RT both as a curative modality and a modality with a palliative aim …”

“…With rapid advances in technology and biological research, the application of radiotherapy (RT) for HCC is increasing globally as one of the potent local modalities . There is growing evidence that transarterial chemoembolization (TACE) followed by RT shows superior outcomes for locally advanced HCC, including portal vein tumor thrombosis, than TACE or sorafenib alone .…”

“…With rapid advances in technology and biological research, the application of radiotherapy (RT) for HCC is increasing globally as one of the potent local modalities. [7][8][9][10] There is growing evidence that transarterial chemoembolization (TACE) followed by RT shows superior outcomes for locally advanced HCC, including portal vein tumor thrombosis, than TACE or sorafenib alone. 9,[11][12][13] On the contrary, prospective trials have shown remarkable effects of immune checkpoint inhibitors (ICI) including nivolumab, as effective systemic agents, in terms of longterm sustained objective response rate in advanced HCC patients.…”